Medtronic, Inc.

Edward Chinchoy

Thomas J Mullen

Rajan Prakash

Michael F Hess

Kathryn Hilpisch

John E Burnes

Barbro M Kjellstrom

Nirav Vijay Sheth

A system and method for monitoring at least one chamber of a heart (e.g., a left ventricular chamber) during delivery of extrasystolic stimulation to determine if the desired extra-systole (i.e., ventricular mechanical capture following refractory period expiration) occurs. The system includes an implantable or external cardiac stimulation device in association with a set of leads such as epicardial, endocardial, and/or coronary sinus leads equipped with motion sensor(s). The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of chamber capture resulting from one or more pacing stimulus delivered closely following expiration of the refractory period. A threshold optimization method optionally evaluates capture and at least one of: runs an iterative routine to establish or re-establish chamber capture for the PESP therapy, sets a logical flag relating to chamber capture status and stores parameter(s) relating to successful chamber capture for one or more subsequent cardiac cycles.

Mechanical ventricular pacing capture detection for a post extrasystolic potentiation (PESP) pacing therapy using at least one lead-based accelerometer

During diastolic coronary perfusion, blood perfuses through the heart via the coronary arteries. Delivery of a therapeutic and/or diagnostic agent to the heart during diastolic coronary perfusion allows the therapeutic and/or diagnostic agent to efficiently perfuse through the heart. A medical device according to the invention detects closure of the aortic valve of a heart, and initiates delivery of a therapeutic and/or diagnostic agent upon detection of aortic valve closure. The medical device detects aortic valve closure by processing a signal. Exemplary signals used by the medical device to detect aortic valve closure include left or right ventricular accelerometer signals, left or right ventricular flow signals, left or right ventricular pressure signals, aortic pressure signals, pulse pressure signals, systemic arterial pressure signals, electrogram signals, and phonocardiogram signals.

Diastolic coronary perfusion detection for timed delivery of therapeutic and/or diagnostic agents

A system and method for monitoring left ventricular (LV) lateral wall motion and for optimizing cardiac pacing intervals based on left ventricular lateral wall motion is provided. The system includes an implantable or external cardiac stimulation device in association with a set of leads including a left ventricular epicardial or coronary sinus lead equipped with a motion sensor electromechanically coupled to the lateral wall of the left ventricle. The device receives and processes wall motion sensor signals to determine a signal characteristic indicative of systolic LV lateral wall motion or acceleration. An automatic pacing interval optimization method evaluates the LV lateral wall motion during varying pacing interval settings, including atrial-ventricular intervals and inter-ventricular intervals and selects the pacing interval setting(s) that correspond to LV lateral wall motion associated with improved cardiac synchrony and hemodynamic performance.

Method and apparatus for assessing left ventricular function and optimizing cardiac pacing intervals based on left ventricular wall motion

During diastolic coronary perfusion, blood perfuses through the heart via the coronary arteries. Delivery of a therapeutic and/or diagnostic agent to the heart during diastolic coronary perfusion allows the therapeutic and/or diagnostic agent to efficiently perfuse through the heart. A medical device according to the invention detects closure of the aortic valve of a heart, and initiates delivery of a therapeutic and/or diagnostic agent upon detection of aortic valve closure. The medical device detects aortic valve closure by processing a signal. Exemplary signals used by the medical device to detect aortic valve closure include left or right ventricular accelerometer signals, left or right ventricular flow signals, left or right ventricular pressure signals, aortic pressure signals, pulse pressure signals, systemic arterial pressure signals, electrogram signals, and phonocardiogram signals

A method for use in an implantable medical device, comprising: sensing a signal corresponding to ventricular wall acceleration; and determining a metric of atrial function using the ventricular wall acceleration signal. The method includes sensing the ventricular wall acceleration signal during at least during a sensing window corresponding to a ventricular filling phase.

Method and apparatus for monitoring and optimizing atrial function

A system and method for monitoring at least one chamber of a heart (e.g., a left ventricular chamber) during delivery of a refractory period stimulation (RPS) therapy to determine if the desired non-capture (i.e., lack of ventricular mechanical capture due to refractory period stimulation) occurs. The system includes an implantable or external cardiac stimulation device in association with a set of leads such as epicardial, endocardial, and/or coronary sinus leads equipped with motion sensor(s). The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of chamber capture due to pacing stimulus delivery, non-capture due to RPS therapy delivery, and/or contractile status based on the qualities of evoked response to pacing stimulation.

Mechanical ventricular pacing non-capture detection for a refractory period stimulation (RPS) pacing therapy using at least one lead-based accelerometer

Determining an optimal atrioventricular interval is of interest for proper delivery of cardiac resynchronization therapy. Although device optimization is gradually and more frequently being performed through a referral process with which the patient undergoes an echocardiographic optimization, the decision of whether to optimize or not is still generally reserved for the implanting physician. Recent abstracts have suggested a formulaic approach for setting A-V interval based on intrinsic electrical sensing, that may possess considerable appeal to clinicians versus a patient average nominal A-V setting of 100 ms. The present invention presents a methods of setting nominal device settings based on entering patient cardiac demographics to determine what A-V setting may be appropriate. The data is based on retrospective analysis of the MIRACLE trial to determine what major factors determined baseline A-V settings.

Method and apparatus for determining an efficacious atrioventricular delay interval

An implantable medical device system and associated method are provided for measuring an excitation-physiological response delay. The method includes sensing a first signal responsive to electrical activity in a first cardiac chamber, sensing a second signal responsive to a physiologic response to the electrical activity in the first cardiac chamber; and determining an excitation-physiologic response delay in response to the first signal and the second signal.

Method and apparatus for determining excitation-physiologic response delays

A method for determining an optimal pacing timing control parameter setting is provided for use in an implantable medical device programmed to deliver a pacing pulse in response to the timing control parameter. The method includes storing a user-selected optimization metric, iteratively adjusting the timing control parameter setting, sensing a first signal that varies in response to left ventricular wall acceleration, measuring the user-selected optimization metric in response to the sensed first signal, and determining an optimal timing control parameter value in response to the measured user-selected optimization metric.

Method and apparatus for determining optimal pacing therapy timing intervals

A method and apparatus for optimizing cardiac resynchronization therapy are provided. An iterative optimization procedure is performed to test the systolic hemodynamic effects of varying A-V-V timing schemes. The hemodynamic effect is assessed based on a surrogate of stroke volume. The stroke volume surrogate is derived from a sensor signal proportional to the blood pressure in the aorta or a major artery. The A-V-V timing scheme corresponding to the highest magnitude stroke volume, as indicated by the stroke volume surrogate, is identified and automatically programmed to maintain optimal A-V-V settings acutely and chronically.

Method and apparatus for optimizing cardiac resynchronization therapy

A method and apparatus for determining a metric of cardiac ventricular synchronization and optimizing a cardiac therapy based on the ventricular synchronization metric are provided. A ventricular synchronization metric is determined by: monitoring right and left ventricular pressure; plotting right ventricular pressure as a function of left ventricular pressure to form an RVP-LVP loop; and integrating with respect to direction to determine an area of the RVP-LVP loop which, according to one convention, is mathematically negative during left ventricular led pressure development and is mathematically positive during right ventricular led pressure development. Timing parameters used to control the delivery of cardiac resynchronization therapy or ventricular assist device therapy are adjusted as needed according to the ventricular synchronization metric.

Method and apparatus for evaluating and optimizing ventricular synchronization

A medical device chronically monitors cardiac function in a patient. An input circuit of the medical device receives a pressure signal representative of a pressure sensed within a ventricle of the patient's heart as a function of time. A processor derives from the pressure signal a myocardial performance index based upon pressures in the ventricle. The processor then provides an output based upon the myocardial performance index.

System and method for monitoring myocardial performance using sensed ventricular pressures

A system and method for monitoring left ventricular cardiac contractility and for optimizing a cardiac therapy based on left ventricular lateral wall acceleration (LVA) are provided. The system includes an implantable or external cardiac stimulation device in association with a set of leads including a left ventricular epicardial or coronary sinus lead equipped with an acceleration sensor. The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of LVA during isovolumic contraction. A therapy optimization method evaluates the LVA during varying therapy settings and selects the setting(s) that correspond to a maximum LVA during isovolumic contraction. In one embodiment, the optimal inter-ventricular pacing interval for use in cardiac resynchronization therapy is determined as the interval corresponding to the highest amplitude of the first LVA peak during isovolumic contraction.

Method and apparatus for optimizing cardiac resynchronization therapy based on left ventricular acceleration

A method and apparatus for optimizing cardiac resynchronization therapy are provided. An iterative optimization procedure is performed to test the systolic hemodynamic effects of varying A-V-V timing schemes. The hemodynamic effect is assessed based on a surrogate of stroke volume. The stroke volume surrogate is derived from a sensor signal proportional to the blood pressure in the aorta or a major artery. The A-V-V timing scheme corresponding to the greatest stroke volume, as indicated by the stroke volume surrogate, is identified and automatically programmed to maintain optimal A-V-V settings acutely and chronically.

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Golden Valley, MN, United States of America

Edward Chinchoy